Imagine you want health care. You go to your doctor who recommends a medication. Your doctor tells you that the medication used to be prescribed one way 14 years ago, but very rigorous, more recent studies indicate a lower dose is just as effective. And has fewer side effects. And is less expensive.

You are pleased because A) your doctor is up on the latest medical therapies and B) the least amount of medication is always best. Except if you want a medical abortion in Arizona. In that situation your doctor can’t offer you the latest state of the art care, she/he will be forced to give you a higher dose of medication in a way that is less optimal. And yes, this is legal.

When the medical abortion regimen involved mifepristone (RU-486 or Mifeprex) and misoprostol was originally submitted for approval to the FDA the literature supported a dose of 600 mg of mifepristone followed by 400 mcg of oral misoprostol 3 days later and only up to 7 weeks. Subsequent studies (because that’s what happens in medicine, doctors continue to study things) have shown that a dose of 200 mg of oral mifepristone followed by 800 mcg of misoprostol vaginally 6-24 hours later is 95-99% effective at terminating a pregnancy up to 63 days gestational age (9 weeks) with fewer side effects and less expense than the older regimen. This 200 mg RU-486 protocol is now (and has been for a while) the standard of care. Except in Arizona

In 2012 Arizona legislators voted to force doctors to go back to the older, higher-dose-more-expense-more-side-effects regimen. Planned Parenthood stepped in and filed suit, however in what sounds like a cruel April Fools’ joke a federal judge refused to block the bill so it went into effect today. Science tells us 600 mg of RU-486 offers nothing positive for the patient or her provider, but somehow a federal judge doesn’t find substandard medical care an undue burden.

So let’s be very clear about this, Arizona lawmakers have stepped into the doctor’s office and insisted medications be prescribed in a way that is no longer supported by medical evidence. And this is legal, because the people who want to advance their personal agendas also write the laws. Why go to a doctor when you can get medical advice from your state legislator! Maybe we can now sue the state for malpractice?

The idea that legislating outdated medical care is not an undue burden is so outlandish that you’d think it would have to be an April Fools’ joke.

It used to be, when I was at medical conferences, that our American colleagues would criticise “socialised medicine” in the UK, in part because they saw it as being subservient to the government’s demands. How times have changed.

Where are the medical associations? When are physicians going to start pushing-back publicly? Doesn’t this interfere with the doctor-patient relationship, and with confidentiality requirements, who’s going to report the doctor for prescribing the correct dosage?